Big-city hospitals are seeing a growing number of patients sticking around long after their care is complete, simply because they have no other place to go. Helen King/CORBIS

January 4, 2012

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Hospitals in big cities are getting stuck caring for "permanent patients" who are well enough to be released, but have nowhere else to go, according to The New York Times. In some cases, these patients wind up staying for years, costing hospitals a fortune. Here, a guide to what these "decidedly unwelcome patients" mean for the nation's health-care system:

How big is this problem?There are an estimated 300 such patients in New York City hospitals alone, and many of the nation's largest urban centers face similar quandaries. It might not sound like a huge drain on the system, but the cost of caring for a single person languishing unnecessarily in a hospital can exceed $100,000 a year. And some of these patients wind up staying as long as five years. "It cost us several million dollars a year," New York Downtown Hospital's former chief medical officer, Dr. Warren B. Licht, tells The New York Times, "in a hospital struggling to keep its head above water."

Who are these patients?Some are poor, or uninsured. Others are illegal immigrants, whose families and home countries won't take them in. They often enter the hospitals for emergency care, which Medicaid frequently pays for. But once the immediate crisis has passed, the coverage stops, and hospitals are stuck with the resulting bill.

Why don't hospitals just kick out "permanent patients"?They're not allowed to discharge people who still need some measure of care — even if it's not directly related to illness — but have no adequate place to go. Under New York law, for example, hospitals can't discharge patients to shelters or to the street. So acute-care facilities like New York Downtown Hospital can wind up keeping patients for years after they could safely be transferred to far less expensive health-care centers, or simply sent home.